Lower Dropout Rates Research Articles

Bestform-F - Best Function of Range of Motion: A Feasibility Study of a Multimodal Exercise Training Program for Older Adults in Retirement Homes.

PurposeMobility is a crucial factor for independence and quality of life in old age. Nevertheless, many old people in retirement homes do not meet the physical activity recommendations. The aim of the Bestform-F – Best Function of Range of Motion feasibility study (bestform-F) was to evaluate the feasibility of implementing a machine-based multimodal exercise training program in older residents in retirement homes.Materials and MethodsThe participants (n = 77) were recruited from two retirement homes and took part in a six-month multimodal exercise training program (2x/week, 45 minutes) on pneumatic strength training machines, a balance platform and bicycle ergometers. Feasibility criteria were recruitment number ≥ 35 participants within six months, dropout rate < 40% of participants within six months of exercise, and training adherence ≥ 50% of participants taking part in at least 50% of offered training sessions. Additionally, physical performance, fear of falling, cognitive function, and quality of life were assessed at baseline and after six months.ResultsFor the bestform-F study, 77 (85.6 ± 6.6 years; 78% women) out of 215 eligible residents from two senior residences were recruited. The dropout rate over six months was 10% (8/77 participants). The training adherence rate for the finishing participants was 77% (53/69 participants). In addition to the achieved feasibility criteria, significant improvements were recorded in the Chair Stand Test, Six-Minute Walk Test, and fear of falling after six months.ConclusionAll feasibility criteria have been fulfilled. The high number of recruited participants, the low dropout rate, and high adherence to the training program confirm the feasibility of a multimodal machine-based exercise training program offered to residents in retirement homes. The results provide a basis for a cluster-randomized controlled trial aimed at further investigating the efficacy of the bestform-F program.

Portraying the Performance of Indonesian’s Massive Open Online Course Facilitators

An Indonesian MOOC (Massive Online Open Course) aimed to give pre- and in-service English teachers a new online learning experience and equip them to master technological applications for teaching English in class. It has not always been easy for facilitators to assist students to complete MOOC programs. This paper sketches how Indonesian facilitators faced challenges in motivating MOOC students. The experience of facilitators with low and high dropout rates is shown to sharpen and deepen the differences in managing the MOOC program. This study found a relationship between facilitator performance and student retention rates.

Evaluation of Dietary Management Using Artificial Intelligence and Human Interventions: Nonrandomized Controlled Trial.

BackgroundThere has been an increase in personal health records with the increased use of wearable devices and smartphone apps to improve health. Traditional health promotion programs by human professionals have limitations in terms of cost and reach. Due to labor shortages and to save costs, there has been a growing emphasis in the medical field on building health guidance systems using artificial intelligence (AI). AI will replace advanced human tasks to some extent in the future. However, it is difficult to sustain behavioral change through technology alone at present.ObjectiveThis study investigates whether AI alone can effectively encourage healthy behaviors or whether human interventions are needed to achieve and sustain health-related behavioral change. We examined the effectiveness of AI and human interventions to encourage dietary management behaviors. In addition, we elucidated the conditions for maximizing the effect of AI on health improvement. We hypothesized that the combination of AI and human interventions will maximize their effectiveness.MethodsWe conducted a 3-month experiment by recruiting participants who were users of a smartphone diet management app. We recruited 102 participants and divided them into 3 groups. Treatment group I received text messages using the standard features of the app (AI-based text message intervention). Treatment group II received video messages from a companion, in addition to the text messages (combined text message and human video message intervention by AI). The control group used the app to keep a dietary record, but no feedback was provided (no intervention). We examine the participants’ continuity and the effects on physical indicators.ResultsCombined AI and video messaging (treatment group II) led to a lower dropout rate from the program compared to the control group, and the Cox proportional-hazards model estimate showed a hazard ratio (HR) of 0.078, which was statistically significant at the 5% level. Further, human intervention with AI and video messaging significantly reduced the body fat percentage (BFP) of participants after 3 months compared to the control group, and the rate of reduction was greater in the group with more individualized intervention. The AI-based text messages affected the BMI but had no significant effect on the BFP.ConclusionsThis experiment shows that it is challenging to sustain participants' healthy behavior with AI intervention alone. The results also suggest that even if the health information conveyed is the same, the information conveyed by humans and AI is more effective in improving health than the information sent by AI alone. The support received from the companion in the form of video messages may have promoted voluntary health behaviors. It is noteworthy that companions were competent, even though they were nonexperts. This means that person-to-person communication is crucial for health interventions.

Design Principles for Integrating Gamification into Distance Learning Programs in Higher Education: A Mixed Method Study

This study aims to address the issue of low completion and high dropout rates in online and distance learning through play and gamification. The general aim of this study is to provide a set of gamification design principles for researchers and practitioners on how gamification can be used in online and distance learning programs in higher education. More specifically, the study intended to seek the answers whether student participation in the online and distance learning programs can be increased by the use of gamification, how the gamification influences the students’ academic performances in the online and distance learning programs and what learners think about integrating gamification into the open and distance learning programs in higher education. The study was designed as a sequential exploratory research, which is one of the mixed research methods. Findings indicate that integrating gamification into the online and distance learning programs has a significant impact on increasing students' visits to the learning environment. In addition, when the pre-gamification and post-gamification scenarios were compared in terms of students accessing to the content in the online and distance learning environment, it was discovered that there was a statistically significant increase. It can be also said that there is significant difference regarding to academic performances for gamified situations. Lastly, gamification is said to be fun by students and to contribute positively to their motivation. According to this, gamification has a positive effect on learners' e-learning behaviors and should be used more in online and distance learning programs.

Clinical role and safety of tapentadol in patients with cancer: A single-center experience.

To evaluate real-world data on the use of tapentadol (TAP) in cancer patients. Single-center retrospective study. Curative/palliative. Patients who started TAP between October 2014 and December 2018 at our institution. The primary outcome was the reason for TAP initiation. Secondary outcomes included prescription duration, TAP cessation rate, reason for cessation, and adverse events (AEs). Since the palliative care team (PCT) tended to prescribe to cancer patients with intractable pain more often than patients in usual care, and also tended to prescribe opioids based on their characteristics, we decided to compare patients with and without PCT intervention. There were 175 patients who first received TAP during the study period, of whom 81 patients (46.3 percent) were male. The median age was 60 years. TAP was prescribed for opioid-naive patients in 45 (26 percent) cases and opioid switch in 130 (74 percent) cases. When comparing the PCT group (n = 121) and the non-PCT group (n = 54) using univariate analysis, the PCT group had a higher opioid switch rate (81.8 percent vs 57.4 percent, p < .001), higher proportion of patients with neuropathic pain (NP) (65.3 percent vs 16.7 percent, p < .001), and a higher proportion of patients with a history of nausea (41.3 percent vs 18.5 percent, p < .01). The cessation rate due to AEs was 8 percent overall. Palliative care physicians prescribed TAP for patients with NP or a history of nausea. Opioid-naive patients were preferred by oncologists. TAP has good tolerability in both groups, with a low dropout rate due to AEs.

MO692: A Four-Year Analysis on Home Dialysis at the North Bristol NHS Trust—What to Do Next?

Abstract BACKGROUND AND AIMS Home dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has been associated with improved patient autonomy, quality of life and overall cost effectiveness (Weinhandl et al. Propensity matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol. 2010; 21: 499–506). The 2021 Get It Right First Time (GIRFT) Renal report revealed that home dialysis patients were at a lower risk of contracting and dying of coronavirus disease 2019 (COVID-19), compared to those who received in-center hemodialysis (ICHD) (2). Despite these advantages, uptake of home dialysis is still lower than that of ICHD. The aim of our study was to analyse the numbers and reasons for home dialysis withdrawal at the North Bristol NHS Trust between 2018 and 2021. METHOD All patients on PD and HHD between 2018 and 2021 were included. Analysis of the episodes that led to home dialysis cessation was carried out. As some patients required withdrawal more than once during the 4-year period, each episode of dropout was considered separately. The prevalence rate of patients on home dialysis was calculated. RESULTS The total number of patients on home dialysis increased from 74 in 2018 to 98 in 2021. The male: female ratio of patients was 3:2 with an average age of 58.3. The number of patients on PD increased from 58 at the end of 2018 to 82 in 2021. The number of patients on HHD remained stable over the years, with an average of 16. The prevalence rate of home dialysis was 17.1% at the end of 2021. Figure 1 shows the total number of patients who started and dropped out of home dialysis every year. The number of patients initiating PD was 58 in 2018, 55 in 2019, 37 in 2020 and 59 in 2021. The number of dropouts was 57 in 2018, 41 in 2019, 29 in 2020 and 43 in 2021. The dip in number of patients initiated on PD in 2020 can be attributed to the start of the COVID-19 pandemic, when elective procedures were temporarily withheld. On the other hand, a lower number dropped out during 2020. This may be explained by the emphasis given to self-isolation rules and persistence with home dialysis during the outbreak. The overall increase in PD uptake in 2021 may be explained by the establishment of a new specialist clinic that promotes the uptake of home dialysis. The initiation of a new peer support service group in 2021 may also have contributed. The number of patients initiating and withdrawing from HHD followed the same pattern, with a significant dip in 2020. Figure 2 demonstrates the reasons for withdrawal from PD over the study period. The most prevalent reasons were PD-related infections and transplantation. The observed figures for transplantation reflect the continuous efforts involved in the maintenance of a successful transplant programme. The figure also shows that termination of PD due to failure was highest in 2021. The authors postulate that this surge might be due to the previous year's low PD dropout rate. The leading reason for stopping HHD was transplantation. Other reasons included recovery of renal function and switching to conservative management. Death led to one dropout/year in 2018–20, but none in 2021. CONCLUSION Around 17% of the NBT’s total dialysis population is currently on home dialysis. The commonest reasons for termination of home dialysis were transplantation and PD-related infections. The GIRFT report recommends that all adult renal units in the UK should reach a minimum prevalence rate of 20% of their dialysis population on home dialysis by the end of 2024 (Lipkin et al. Renal medicine: Get It Right First Time (GIRFT) Programme National Specialty Report. March 2021. NHS England and NHS Improvement). Whereas our statistic falls slightly short of this, we aim to reach this target through various strategies. These include continued audit, home dialysis campaign, continued psychological services and a reduction in waiting time for PD catheter insertion.

Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention?

Migraine is a prevalent disorder and a cause of high disability, influenced by modifiable and non-modifiable risk factors. Comorbid and psychiatric illnesses are prevalent in migraine patients and should be considered when choosing preventive drugs. There have been unforeseen problems with the use of preventive treatment of migraine with oral drugs, mainly due to side-effects that cannot be tolerated and lack of efficacy, leading to high discontinuation rates. Anti-CGRP monoclonal antibodies (mAbs) have shown better tolerance profiles, based on the low dropout rates in clinical trials due to adverse events. First-line therapy is a term most expressed in some medical specialties that adopt standardized protocol treatments and may not be suitable for treating migraine. Regarding efficacy, mAbs don't seem to perform much better than the current prophylactic oral drugs in reduction of monthly migraine days compared to placebo. Monoclonal antibodies against CGRP pathway have been prescribed recently, which raises some concern about their safety in the long term. Only side effects observation will confirm whether CGRP blockade causes susceptibility to severe side-effects, at least to specific subpopulations. CGRP may play a role in regulating uteroplacental blood flow and myometrial and uterine relaxation, as well as blood pressure control, raising the suspicion that its blockade could cause complications during pregnancy. Recent guidelines retain the recommendation of starting preventive treatment of migraine with oral drugs. Both the fact that it is new and costs are the reason why guidelines recommend the prescription of mAbs only after failure of at least two oral drugs.

Exercise With Low-Loads and Concurrent Partial Blood Flow Restriction Combined With Patient Education in Females Suffering From Gluteal Tendinopathy: A Feasibility Study.

IntroductionTo date, there exists no gold standard conservative treatment for lateral hip pain due to tendinopathy of the gluteus medius and/or minimus tendon (GT), a condition often complicated by pain and disability. Higher loads during everyday activities and exercise seems to be contraindicated with GT. The purpose of this study was to evaluate the feasibility of exercise with low-loads concurrent partial blood flow restriction (LL-BFR) and patient education for patients present GT.MethodsRecruitment took place at three hospitals in the Central Denmark Region. The intervention consisted of daily sessions for 8 weeks with one weekly supervised session. From week three patients exercised with applied partial blood flow restriction by means of a pneumatic cuff around the proximal thigh of the affected leg. Throughout the intervention patients received patient education on their hip condition. Sociodemographic and clinical variables were collected at baseline. The feasibility of LL-BFR was conducted by adherence to the exercise protocol and drop-out rate. Patient reported outcome measures (The Victorian Institute of Sport Assessment-Gluteal Questionnaire, EuroQol - 5 Dimensions-Visual Analogue Scale, Oxford Hip Score, Copenhagen Hip and Groin Outcome Score), maximal voluntary isometric hip abduction-, hip extension, and knee extension strength (Nm/kg) measured using a handheld dynamometer, and functional capacity tests (30 second chair-stand test and a stair-climb test) was conducted as secondary outcomes.ResultsSixteen women with a median (IQR) age of 51 (46–60) years were included. Median (IQR) Body Mass Index was 26.69 (23.59–30.46) kg/m2. Adherence to the total number of training sessions and the LL-BFR was 96.4 and 94.4%, respectively. Two patients dropped out due to (i) illness before initiation of LL-BFR and (ii) pain in the affected leg related to the LL-BFR-exercise. At follow-up both pain levels and patient-reported outcome measures improved. Isometric hip abduction-, hip extension-, and knee extension strength on both legs and functional performance increased. Conclusion: LL-BFR-exercise seems feasible for treatment of GT. At follow-up, a high adherence and low drop-out rate were observed. Further, patients reported clinically relevant reductions in pain, and showed significant increases in isometric hip and knee strength.

Does free education reduce early school dropouts? Evidence from a legislative reform in India

We examine the role of free elementary education in reducing elementary school dropouts in India following the legislative reform on provision of Universal Education in 2009. We find that the impact was significant across all districts on average, but was notably higher for those at lower levels of development. Our results highlight the importance of removing barriers to schooling mainly in the form of costs that enable children in poorer areas to continue schooling. Provisions of infrastructural facilities such as toilets are also found to play a significant role in reducing dropouts. Further, our findings indicate the need for developing amenities for disabled children. Higher literacy rates are significantly associated with lower dropout rates indicating the urgent need for targeted government policies that can uplift generations out of a perpetuating education trap.

The associations between motivational climate, basic psychological needs and dropout in volleyball – A comparison across competitive levels

ABSTRACT The purpose of this study was to investigate the importance of motivational climate for the satisfaction of psychological needs and dropout in recreational, intermediate and elite volleyball. Seven thousand nine hundred thirty six volleyball players from all 321 volleyball clubs across Denmark were invited to participate in the study. Three thousand three thirty answered the questionnaire and 2150 were included in the analysis. Dropout from Volleyball was measured as the proportion of players that had stopped playing volleyball over the last year. The coach-created motivational climate was measured using the Motivational Climate Scale for Youth Sports. The satisfaction of players’ psychological needs was measured using an adapted version of the basic psychological needs in exercise scale. The psychometric scales were validated and showed good model fit. For volleyball players of all levels, the degree of mastery climate predicted the satisfaction of the players’ basic psychological needs satisfaction during volleyball which was, in turn, associated with lower dropout rates. Performance climate had a weak negative association with the satisfaction of psychological needs on the intermediate level only. When adjusting the models for the negative association between performance climate and mastery climate this negative association became nonsignificant and a weak positive association to needs satisfaction emerged for players at the elite level. Findings confirm that the coach-created mastery climate in volleyball teams is important for the satisfaction of players’ basic psychological needs and continuation within the sport across the recreational, intermediate and elite levels. Highlights Coach-created mastery climate in volleyball teams was positively associated with the satisfaction of the players’ basic psychological and negatively associated with dropout. These associations between coach created climate, need satisfaction and dropout were similar across different sporting levels. Performance orientation had little influence and seemed mainly problematic if it was at the expense of mastery climate.

A Comparison of Census and Cohort Sampling Models for the Longitudinal Collection of User-Reported Data in the Maternity Care Pathway: Mixed Methods Study.

BackgroundTypical measures of maternity performance remain focused on the technical elements of birth, especially pathological elements, with insufficient measurement of nontechnical measures and those collected pre- and postpartum. New technologies allow for patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) to be collected from large samples at multiple time points, which can be considered alongside existing administrative sources; however, such models are not widely implemented or evaluated. Since 2018, a longitudinal, personalized, and integrated user-reported data collection process for the maternal care pathway has been used in Tuscany, Italy. This model has been through two methodological iterations.ObjectiveThe aim of this study was to compare and contrast two sampling models of longitudinal user-reported data for the maternity care pathway, exploring factors influencing participation, cost, and suitability of the models for different stakeholders.MethodsData were collected by two modes: (1) “cohort” recruitment at the birth hospital of a predetermined sample size and (2) continuous, ongoing “census” recruitment of women at the first midwife appointment. Surveys were used to collect experiential and outcome data related to existing services. Women were included who passed 12 months after initial enrollment, meaning that they either received the surveys issued after that interval or dropped out in the intervening period. Data were collected from women in Tuscany, Italy, between September 2018 and July 2020. The total sample included 7784 individuals with 38,656 observations. The two models of longitudinal collection of user-reported data were analyzed using descriptive statistics, survival analysis, cost comparison, and a qualitative review.ResultsCohort sampling provided lower initial participation than census sampling, although very high subsequent response rates (87%) were obtained 1 year after enrollment. Census sampling had higher initial participation, but greater dropout (up to 45% at 1 year). Both models showed high response rates for online surveys. There were nonproportional dropout hazards over time. There were higher rates of dropout for women with foreign nationality (hazard ratio [HR] 1.88, P<.001), and lower rates of dropout for those who had a higher level of education (HR 0.77 and 0.61 for women completing high school and college, respectively; P<.001), were employed (HR 0.87, P=.01), in a relationship (HR 0.84, P=.04), and with previous pregnancies (HR 0.86, P=.002). The census model was initially more expensive, albeit with lower repeat costs and could become cheaper if repeated more than six times.ConclusionsThe digital collection of user-reported data enables high response rates to targeted surveys in the maternity care pathway. The point at which pregnant women or mothers are recruited is relevant for response rates and sample bias. The census model of continuous enrollment and real-time data availability offers a wider set of potential benefits, but at an initially higher cost and with the requirement for more substantial data translation and managerial capacity to make use of such data.

Effectiveness and acceptability of noninvasive brain and nerve stimulation techniques for migraine prophylaxis: a network meta-analysis of randomized controlled trials

BackgroundCurrent pharmacologic prophylactic strategies for migraine have exhibited limited efficacy, with response rates as low as 40%–50%. In addition to the limited efficacy, the acceptability of those pharmacologic prophylactic strategies were unacceptable. Although noninvasive brain/nerve stimulation strategies may be effective, the evidence has been inconsistent. The aim of this network meta-analysis (NMA) was to compare strategies of noninvasive brain/nerve stimulation for migraine prophylaxis with respect to their effectiveness and acceptability.MethodsThe PubMed, Embase, ScienceDirect, ProQuest, ClinicalTrials.gov, ClinicalKey, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov databases were systematically searched to date of June 4th, 2021 for randomized controlled trials (RCTs). Patients with diagnosis of migraine, either episodic migraine or chronic migraine, were included. All NMA procedures were conducted under the frequentist model.ResultsNineteen RCTs were included (N = 1493; mean age = 38.2 years; 82.0% women). We determined that the high frequency repetitive transcranial magnetic stimulation (rTMS) over C3 yielded the most decreased monthly migraine days among all the interventions [mean difference = − 8.70 days, 95% confidence intervals (95%CIs): − 14.45 to − 2.95 compared to sham/control groups]. Only alternating frequency (2/100 Hz) transcutaneous occipital nerve stimulation (tONS) over the Oz (RR = 0.36, 95%CIs: 0.16 to 0.82) yielded a significantly lower drop-out rate than the sham/control groups did.ConclusionsThe current study provided a new direction for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on migraine prophylaxis in participants with migraine by different noninvasive brain/nerve stimulation, especially the application of rTMS and tONS.Trial registrationCRD42021252638. The current study had been approval by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No. B-109-29).

Factors affecting language policy choices in the multilingual context of Namibia

As most African countries, Namibia is multilingual, but the linguistic diversity is not fully appreciated nor supported in the language education policy. Nationalist one nation – one language ideologies and policy makers' desire to remove Afrikaans from its former power position and replacing it with English have affected the choices of the official language and the medium of instruction policies. The current language education policy has contributed to low academic achievements and high school dropout rates. This article discusses the development of the language education policy in independent Namibia within the critical language policy framework. The language education policy is re-evaluated from a historical perspective in order to understand the current situation and the recent developments. The method is historical-structural analysis of institutional texts. The focus is on the choice of the official language and the medium of instruction policy. The covert policy is analysed in light of educational statistics and examination results. The analysis reveals that the language education policy has remained almost the same during the years of independence, and the efforts of extending mother tongue instruction to senior primary have not been successful. Despite the twofold emphasis of the overt policy of promoting the local languages and making the citizens proficient in English, the covert policy is more English-oriented. Multilingual teaching practices and pedagogies, including translanguaging, are discussed as a feasible option to promote more flexible multilingual education and to strengthen the learners' multilingual identities.

Low drop-out rates in the HandbikeBattle free-living training study: understanding the reasons for dropping out.

Longitudinal observational study. During the five-month free-living training period for the HandbikeBattle event several participants dropped out. The aim of this study was to clarify the numbers and reasons for drop out, and to characterize the differences between study participants who did (dropouts) and did not (competitors) drop out during the training period for the HandbikeBattle event. Former participants of the HandbikeBattle, a handcycling race on an Austrian mountain. Participants (N = 313 (N = 209 (67%) with spinal cord injury or spina bifida)) enrolled between 2013-2018. Drop out and reasons for drop out were registered. Competitors and dropouts were compared regarding personal, disability, physical, and psychological factors, which were measured at the start of the training period. Forty-five participants (14%) dropped out during the training period with medical complications (49%) and motivational problems (29%) as main reasons. The only differences were that competitors participated more in sports before the study (p = 0.01) and achieved a higher peak power output (p = 0.04) compared to dropouts. The drop-out rate of the HandbikeBattle study was low compared to previous exercise intervention studies, which might be related to the less strictly imposed free-living training. Persons with less experience in sport and a lower fitness level might need more attention during a training intervention to prevent them from dropping out.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Portugal: Feasibility Study Results.

The Unified Protocol for Children (UP-C) is a transdiagnostic Cognitive-Behavioral Therapy group intervention for children and caregivers targeting the treatment of children’s emotional disorders (EDs). The present study aims to assess the feasibility and acceptability of the UP-C in the Portuguese population using a single-armed design. The participants were 32 children (6–12 years of age) with an ED (anxiety and/or depressive disorder) as a main diagnosis and their parents. All participants received the UP-C intervention and were assessed at pretreatment, midtreatment, posttreatment, and 3 months posttreatment. Children, parents, the clinicians, and an external observer completed questionnaires to assess the feasibility and acceptability of the UP-C (e.g., satisfaction, motivation, and adherence). Children and parents also completed self-report measures assessing the children’s anxiety and depression and its interference and severity. The results of the present study support the feasibility and acceptability of the UP-C in Portugal; low dropout rates, high adherence rates, and high levels of child and parent satisfaction and motivation were observed. Moreover, significant reductions over time in children’s levels of anxiety and/or depression and of its interference and severity were found and were maintained after 3 months of follow-up. These results are promising and warrant a subsequent randomized controlled trial (RCT).

Lower academic performance and dropout rates among University students with children: a prospective cohort study of nursing students in Bogotá, Colombia.

To determine the association between parenthood and academic performance and dropout among professional Nursing degree program students. A prospective cohort was conducted. 310 students were included, 26 parents (exposed) and 284 nonparents (unexposed), who were followed up during 16 weeks. At the end of this follow-up, student records were reviewed. Academic performance in the exposed and unexposed groups was 3.51/5.0 and 3.64/5.0 respectively. Although it was higher in the latter group, i.e., with a difference of 0.13, the values were not statistically significant (p=0.058). After adjusting for confounding variables, a difference of -0.165 point was seen (p=0.037). The risk of students dropping out of college is 34 % less for exposed compared to those who are unexposed (RR: 0.66; CI: 0.075-5.78; p=0.708). The results suggest that parenthood has a modest impact on the academic performance, and has no impact on the risk of dropping out.

Career and Technical Education's Unequal Dividends for High School Students: The Stratification of a New Generation

We examined the relationships between high school CTE participation and indicators of career and college readiness using 2009 High School Longitudinal Study restricted-use data. Regression analyses of 2009–2018 data revealed significantly lower dropout rates for CTE participants, but only White CTE participants experienced better employment likelihood. CTE participants were mostly employed in service or manual labor occupations with below average wages and were significantly less likely to attend a 4-year college. CTE benefits were disproportionate by race and gender, and participation may have a “cooling out” effect on the aspirations of some students. Advising and urban education implications are discussed.

Effect of Written Exposure Therapy vs Cognitive Processing Therapy on Increasing Treatment Efficiency Among Military Service Members With Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) occurs more commonly among military service members than among civilians; however, despite the availability of several evidence-based treatments, there is a need for more efficient evidence-based PTSD treatments to better address the needs of service members. Written exposure therapy is a brief PTSD intervention that consists of 5 sessions with no between-session assignments, has demonstrated efficacy, and is associated with low treatment dropout rates, but prior randomized clinical trials of this intervention have focused on civilian populations. To investigate whether the brief intervention, written exposure therapy, is noninferior in the treatment of PTSD vs the more time-intensive cognitive processing therapy among service members diagnosed with PTSD. The study used a randomized, noninferiority design with a 1:1 randomization allocation. Recruitment for the study took place from August 2016 through October 2020. Participants were active-duty military service members diagnosed with posttraumatic stress disorder. The study was conducted in an outpatient setting for service members seeking PTSD treatment at military bases in San Antonio or Killeen, Texas. Participants received either written exposure therapy, which consisted of 5 weekly sessions, or cognitive processing therapy, which consisted of 12 twice-weekly sessions. Participants were assessed at baseline and at 10, 20, and 30 weeks after the first treatment session. The primary outcome measure was PTSD symptom severity assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Noninferiority was defined as the difference between the 2 groups being less than the upper bound of the 1-sided 95% CI-specified margin of 10 points on the CAPS-5. Overall, 169 participants were included in the study. Participants were predominantly male (136 [80.5%]), serving in the Army (167 [98.8%]), with a mean (SD) age of 34 (8) years. Eighty-five participants were randomly assigned to written exposure therapy, with 65 (76.5%) completing all treatment sessions, and 84 to cognitive processing therapy, with 47 (54.8%) completing all treatment sessions. Findings indicated that written exposure therapy was noninferior to cognitive processing therapy, with the largest difference in change in outcome between the treatment conditions of 3.96 points on the outcome measure. The 1-sided 95% CI upper limit was less than 10 points across time points in both groups and ranged from 4.59 at week 30 to 6.81 at week 10. Within-condition effect sizes ranged from a Cohen d of 0.48 for the written exposure therapy group in the intention-to-treat analysis at week 10 to 0.95 for the cognitive processing therapy group in the per-protocol analysis at week 10, and between-condition effect size ranged from 0.06 in the intention-to-treat analysis at week 30 to 0.22 in the per-protocol analysis at week 10. In this randomized clinical trial, support was found for an effective and more efficient PTSD treatment approach for service members. Future research should determine who does and does not benefit from PTSD treatment to best maximize treatment outcomes. ClinicalTrials.gov Identifier: NCT03033602.

Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study

BackgroundOverall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces including Kinshasa, the capital of the DRC, is launched to reinforce routine immunization. Mont Ngafula II was the only health district that experienced high vaccination dropout rates for nearly five consecutive years. This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district.MethodsA cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from the local health district authority and mapped. Logistic random effects regression models were used to identify predictors of high vaccination dropout rates.ResultsOf the 14 health areas in the Mont Ngafula II health district, four reported high vaccine coverage, only one recorded low vaccine coverage, and three reported both low vaccine coverage and high dropout rate. In the final multivariate logistic random effects regression model, the predictors of immunization dropout among children aged 12-23 months were: living in rural areas, unavailability of seats, non-compliance with the order of arrival during vaccination in health facilities, and lack of a reminder system on days before the scheduled vaccination.ConclusionsOur results advocate for prioritizing targeted interventions and programs to strengthen interpersonal communication between immunization service providers and users during vaccination in health facilities and to implement an SMS reminder system on days before the scheduled vaccination.

Comparing success of female students to their male counterparts in the STEM fields: an empirical analysis from enrollment until graduation using longitudinal register data

BackgroundIn this paper, we investigate the predictors for enrollment and success in Science, Technology, Engineering, and Mathematics (STEM) programs in higher education. We develop a sequential logit model in which students enroll in STEM education, may drop out from STEM higher education, or continue studying until they graduate in an STEM field. We use rich Dutch register data on student characteristics and high school exam grades to explain the differences in enrollment, success, and dropout rates.ResultsWe find that females are less likely to enroll in STEM-related fields, while students with higher high school mathematics grades are more likely to enroll in STEM. Female students have lower first-year dropout rates at university of applied sciences STEM programs. With respect to study success, we find that conditional on enrollment in STEM, women are less likely to graduate than men within the nominal duration or the nominal duration plus one additional year. However, female students do perform equally well as male students in terms of graduation within 10 years.ConclusionsWe conclude that STEM programs are less popular among female students and that female students are less likely to graduate on time. However, females perform equally well in STEM higher education in the long run. For this reason, policy should be geared at increasing study success in terms of nominal graduation rates among female STEM students.